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PubMed1995

Ergonomics of the physical environment: international ergonomics standards concerning speech communication, danger signals, lighting, vibration and surface temperatures.

This paper considers standards relevant to environmental ergonomics, and includes those that have been, or are likely to be, produced by the International Organization for Standardization (ISO), under ISO TC 159 SC5 'Ergonomics of the physical environment' and working groups of CEN TC 122 'Ergonomics'. It includes descriptions of standards concerned with speech communication in noisy environments, visual and auditory danger signals, lighting, vibration, skin contact with hot surfaces and others. It is noted that for historical and organizational reasons, some standards relevant to this area are not developed by ergonomics standards committees. The ergonomist can use international standards to ensure use of the best available data and internationally accepted methods. Standards will not determine workplace design but can provide a useful 'starting point' for successful design.

Journal Article↗

PubMed1982

On the optimization of blood lead standards in electrothermal atomization atomic absorption spectrometry.

This study is concerned with the optimization of blood lead standards in EDTA-AAS (electrothermal atomisation-atomic absorption spectrometry), using a direct method, i.e. the determination of lead in 15-fold diluted blood. With three bottles of whole blood containing respectively heparin, citrate and EDTA as an anticoagulant, and 14 working standard solutions, 42 calibration curves were constructed. It appeared that standards prepared in heparinised blood yield calibration curves with a less steep slope than in the case of citrate of EDTA blood. As a primary standard, lead acetate is considered best for both heparinised and citrated blood; metallic lead is advantageous for EDTA blood. In all cases a low pH of both stock standard and working standard solution is preferred. Using a reference sample the best conditions for obtaining accurate results were investigated. The use of metallic lead as a primary standard ensures a combination of low systemic error with high precision and steep slope.

Anticoagulants↗

PubMed1988

A single ECG lead in the serial monitoring of ischemic injury and necrosis in patients with acute anterior myocardial infarction: comparison with 49-lead precordial maps and standard ECGs.

To evaluate the single ECG lead with the maximal ST-segment elevation on admission as a modality suitable for monitoring ischemic injury and necrosis, the author correlated the single lead from 49-lead precordial maps and that from the corresponding standard ECGs with the ECG systems from which they derived. A total of 265 pairs of studies (14 per patient) from 20 patients with acute anterior myocardial infarction were used. Serial recordings were done on admission, at 12 predetermined time intervals during hospitalization, and at discharge. The amplitudes of ST-segment elevation, R waves, and Q waves of the single lead and all of the complexes of the corresponding precordial maps or standard ECGs were measured, using the same methodology. The single ECG lead correlated well with the precordial maps and the standard ECG. Although in serial studies the originally selected single lead was not the one displaying the maximal ST-segment elevation in 29% of the studies, it was always located on a locus immediately adjacent to the new lead in the grid recording the maximal ST. Changes in the precordial map or standard ECG were always detected by the corresponding single lead. The single lead from the standard ECG reflected changes in the precordial map, indicating that a precordial map is not necessary on admission for identification of the single lead. Correlations of R waves and Q waves from the single lead and the precordial map or the single lead and the standard ECG were not as good as the ones found for ST-segment elevation, although they provided monitoring of directional changes of the QRS complexes during hospitalization. Thus, a single lead from a precordial map or standard ECG is adequate for monitoring of the magnitude of ischemic injury in patients with acute anterior myocardial infarction. The single lead also provides some information as to the evolution of changes in the precordial QRS complexes associated with infarction and maintains its traditional role of providing surveillance for arrhythmias or conduction abnormalities.

Adult↗

PubMed1994

World standards for surgical implants: an American perspective.

Working cooperation among surgeons, manufacturers and scientists, working in many countries, over the last forty years has arrived at minimal standards. These standards are for both the materials to be used in the manufacture of surgical implants and for the design and performance of the implants themselves. An account is given here of the development of the standards writing procedure in the United States and the International Standards Organization in Geneva. The important contributions of all the working groups to write the present standards is underline. This process has been set up within the European countries, the United States of America, Canada and other nations, to make sure that materials are adequately investigated prior to their use for the manufacture of surgical implants. In addition the implants themselves must satisfy design requirements which have been set up by consensus, this allows for the expression of all interests. This is an account of what has been going on in standards writing and continues to take place in the writing of standards.

Biocompatible Materials↗

PubMed1982

Standard setting: the crucial issues. A case study of accounting & auditing.

A study of standard-setting efforts in accounting and auditing is reported. The study reveals four major areas of concern in a professional standard-setting effort: (1) issues related to the rationale for setting standards, (2) issues related to the standard-setting board and its support structure, (3) issues related to the content of standards and rules for generating them, and (4) issues that deal with how standards are put to use. Principles derived from the study of accounting and auditing are provided to illuminate and assess standard-setting efforts in evaluation.

Accounting↗

PubMed1992

Current status of Image Save and Carry (IS&C) standardization.

Image Save And Carry (IS&C) was planned to be an off-line information system for transmission and exchange of medical images and information between a medical facility's different divisions as well as between other hospitals. The IS&C committee defines file format for magneto-optical disk, the data format and representation, media compatibility and data security and technological assessment. A 'zone management method' which contributes to a rapid access of data in the recording media is used for IS&C file management. The IS&C standard holds as much conformation as possible in order to coordinate with ACR-NEMA (American College of Radiology-National Electrical Manufacturers' Association) and MIPS (Medical Information Processing Systems) standards. The IS&C data format is based upon the ACR-NEMA/MIPS standard. A major difference between the ACR-NEMA/MIPS standard and IS&C standard is that the IS&C standard is expected to serve for recording all kinds of medical information (e.g., diagnostic reports, endoscopic images and electrocardiograms), including X-ray images. Applications to PACS, teaching files, personal electronic health and medical records are promising. The booklet of IS&C standard will be published in the spring of 1992 by the IS&C committee.

Computer Communication Networks↗

PubMed1994

A statistical analysis system macro for age-standardized incidence rates.

The Statistical Analysis System (SAS) is a commercial software system for data analysis. We designed a SAS macro that produces age-specific rates of any given disease directly from the basic patient data on SAS files. The macro conforms to the statistical methods of the World Health Organization's MONICA project, which is a multinational project for MONItoring of trends and determinants in CArdiovascular disease. The data of the Coronary Register of the City of Turku, Finland, was used to test this macro. The data consists of both men and women between the ages of 35 and 64 years. Acute coronary events leading to hospitalization and acute coronary death events outside hospital have been registered since 1972. For age-standardization Segi's world population was used as the standard. The weights were then calculated for five consecutive years. Individual weights related to the population size of the reporting unit and the standard population were calculated for each subject in the population using the population size of the reporting unit and the standard population. This yielded the age-standardized rates of the acute myocardial infarction and the corresponding standard deviations. The macro permits standardization of the incidence rates of any disease. It will present the required figures instantly.

Adult↗

PubMed1995

Success, failures and costs of implementing standards in the USA--lessons for infection control.

In the US, extensive standards for performance and 'guidelines for practice' have been instituted by a number of governmental and non-governmental agencies. New governmental plans for health care depend heavily on practice guidelines, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has been especially enthusiastic about continuous quality improvement. Monitoring the appropriateness of care and altering physician practice appeals to insurance carriers and health care management organizations. Some initial data exist to show that the quality of health care has been enhanced by these regulations. The total cost for health care administration in 1990 in the USA was 24.8% of each hospital's spending for health care. Much of this was associated with spending for new initiatives in practice guidelines, physician profiling, quality assurance, and the like. Few data exist to show that the quality of health care or hospital infection control has been enhanced by these expenditures. Regulations and guidelines also have proliferated in infection control. Guides from the JCAHO have been expanded, and recent mandates from the Occupational Health and Safety Administration (OSHA) for protecting employees from blood-borne and respiratory pathogens promise to be especially costly for health care organizations to implement. Little data exist to show that the quality of infection control has been enhanced by these regulations. Standards are difficult to develop, because the science to back them up often is lacking, interpretation of validating data is imprecise, and inherent biological variation makes exceptions common. Seven lessons are important for those developing standards today. These include focusing on objective measures of the impact of the standard, clearly indicating the degree of scientific validity, making the development process inclusive, allowing for local variation, making sure that funding is provided for mandated standards, considering non-scientific implications of standards, and remaining involved in the process after the guideline is developed. Infection control workers should make sure that standards developed take the lessons above into account before they are promulgated.

Financial Support↗

PubMed1994

Teenage alcohol drinking and non-standard family background.

The teenage alcohol drinking in 1980 is described in a cohort of 12,058 subjects born in Northern Finland in 1966, with special reference to non-standard families (with one or both parents absent). The percentage of boys (girls) who had been drinking alcohol at the age of 14 years, was 59.1 (58.3)%, being 57.5 (55.6%) in standard, full families and 66.0 (69.0)% in non-standard families. The percentage of having been drunk was 25.2 (25.1)%, or 22.8 (22.1)% in full families and 36.1 (37.1)% in the non-standard families. When adjusted for the maternal age at birth, place of residence, social class and child's status in the family (firstborn or not, only child or not) by means of regression modelling, the risk of alcohol drinking/having been drunk was still increased in non-standard families, especially in cases of divorce or same-sex parental death, the risk differences as compared to the standard family usually being between 10-20%. The results suggest that a non-standard family structure is associated with early juvenile alcohol drinking. Parental loss or absence may constitute one important factor leading to excessive haste in adopting the adolescent culture, including its potentially destructive habits.

Adolescent↗

PubMed1979

Can drinking water standards be reliably derived from industrial TLVs?

The accuracy of TLV derived drinking water standards is evaluated. When using the identical TLV conversion methodology which Stokinger and Woodward (1) used in deriving the standard for barium in drinking water, standards for arsenic, cadmium, chromium and lead offer 6, 200, 60, and 10 times less protection than the present drinking water standards, respectively. However, using the same methodology, the TLV derived drinking water standard for fluoride offers greater protection than the present standard by a factor of approximately 2. Thus, the use of the TLV conversion factor should be viewed in as one of many lines of potential evidence which should be reviewed in the standard derivation process - but it should not, if at all possible, be considered alone - as in the case of barium.

Arsenic↗

PubMed1995

Factors influencing incidence of acute grade 2 morbidity in conformal and standard radiation treatment of prostate cancer.

PURPOSE: The fundament hypothesis of conformal radiation therapy is that tumor control can be increased by using conformal treatment techniques that allow a higher tumor dose while maintaining an acceptable level of complications. To test this hypothesis, it is necessary first to estimate the incidence of morbidity for both standard and conformal fields. In this study, we examine factors that influence the incidence of acute grade 2 morbidity in patients treated with conformal and standard radiation treatment for prostate cancer. METHODS AND MATERIALS: Two hundred and forty-seven consecutive patients treated with conformal technique are combined with and compared to 162 consecutive patients treated with standard techniques. The conformal technique includes special immobilization by a cast, careful identification of the target volume in three dimensions, localization of the inferior border of the prostate using the retrograde urethrogram, and individually shaped portals that conform to the Planning Target Volume (PTV). Univariate analysis compares differences in the incidence of RTOG-EORTC grade two acute morbidity by technique, T stage, age, irradiated volume, and dose. Multivariate logistic regression includes these same variables. RESULTS: In nearly all categories, the conformal treatment group experienced significantly fewer acute grade 2 complications than the standard treatment group. Only volume (prostate +/- whole pelvis) and technique (conformal vs. standard) were significantly related to incidence of morbidity on multivariate analysis. When dose is treated as a continuous variable (rather than being dichotomized into two levels), a trend is observed on multivariate analysis, but it does not reach significant levels. The incidence of acute grade 2 morbidity in patients 65 years or older is significantly reduced by use of the conformal technique. CONCLUSION: The conformal technique is associated with fewer grade 2 acute toxicities for all patients. This conclusion is valid irrespective of selection criteria except in a few cases. Older age is associated with increased toxicity only with the standard technique and not then at a statistically significant level. Elderly patients should not be excluded from external beam radiation because of increased morbidity especially if conformal treatment is available. Volume is not significantly related to morbidity in patients with standard treatment, but it is for conformal treatment. Furthermore, it remains significant in a multivariate analysis that also shows the advantage of conformal treatment. Grade 2 acute toxicities are more volume dependent than dose dependent.

Age Factors↗

PubMed2005

ADA initiates development of orthodontic informatics standards.

Standards are the key to interoperability across systems. The American Dental Association (ADA) has been accredited by the American National Standards Institute (ANSI) as a standards-developing organization. The ADA sponsors standards programs for all areas of dentistry, including dental materials and products and dental informatics. ANSI/ADA Specification No. 1000, Standard Clinical Data Architecture for the Structure and Content of an Electronic Health Record, is the first ANSI standard that defines the fundamental data structures used to make patient health records. The standard promotes the sharing of like data between dentists, physicians, and hospitals.

American Dental Association↗

PubMed2004

Collaborative study to assess the suitability of a candidate International Standard for yellow fever vaccine.

Yellow fever vaccines are routinely assayed by plaque assay. However, the results of these assays are then converted into mouse LD(50) using correlations/conversion factors which, in many cases, were established many years ago. The minimum required potency in WHO Recommendations is 10(3) LD(50)/dose. Thirteen participants from 8 countries participated in a collaborative study whose aim was to assess the suitability of two candidate preparations to serve as an International Standard for yellow fever vaccine. In addition, the study investigated the relationship between the mouse LD(50) test and plaque forming units with a view to updating the WHO recommendations. Plaque assays were more reproducible than mouse assays, as expected. Differences in sensitivities of plaque assays were observed between laboratories but these differences appear to be consistent within a laboratory for all samples and the expression of potency relative to the candidate standard vaccine improved the reproducibility of assays between laboratories. However, the use of potencies had little effect on the between laboratory variability in mouse LD(50) assays. There appears to be a consistent relationship between overall mean LD(50) and plaques titre for all study preparations other than sample E. The slope of the correlation curve is >1 and it would appear that 10(3) LD(50) is approximately equivalent to 10(4) plaque forming units (PFU), based on the overall means of all laboratory results. The First International Standard for yellow fever vaccine, NIBSC Code 99/616, has been established as the First International Standard for yellow fever vaccine by the Expert Committee of Biological Standards of the World Health Organisation. The International Standard has been arbitrarily assigned a potency of 10(4.5) International Units (IU) per ampoule. Manufacturers and National Control Laboratories are including the First International Standard for yellow fever vaccine in routine assays so that the minimum potency in IU of vaccines released for use and which meet the current minimum potency of 10(3) LD(50) in mouse assays, can be determined. These data will be analysed before a review of the WHO requirements, including the minimum potency per dose, is undertaken.

Animals↗

PubMed2004

The long core needle with an end-cut technique for prostate biopsy: does it really have advantages when compared with standard needles?

OBJECTIVE: To evaluate the failure rate, core length and fragmentation rate for each different stroke length of the end-cut (BioPince) needle in order to show the performance of the needle for different stroke lengths and compare these with the standard side-notch needle. METHODS: TRUS guided biopsy of the prostate was performed on 86 consecutive men between June 2002 and May 2003. The patients were randomized into two groups with 43 men in each group. Patients in group A underwent 8 core biopsy with the end-cut needle in different stroke lengths; 13, 23 and 33mm respectively. Patients in group B underwent 8 core biopsy with the side-notch needle. The cores have been evaluated and compared for failure rates, core lengths, number of core lengths under 5mm and fragmentation rates. RESULTS: When the end-cut needle was used, a significant number of failure rates was noted; with an overall failure rate of 16%. The failure rates were 26% for 13mm stroke length, 18% for 23mm stroke length and 10% for 33mm stroke length respectively. These failure rates showed statistically significant difference from standard needle for overall and for every separate stroke length ( p<0.001 for all). Standard needle and the cores taken with 33mm stroke length of the end-cut needle had similar low fragmentation rates while 13 and 23mm stroke lengths had higher rates. Of the overall cores taken by BioPince needle, 46/344 (13%) of the cores were shorter than 5mm and this was significantly higher than the standard needle with 3/344 cores less than 5mm ( p<0.001). The end-cut needle when used with the 33mm stroke length has improved the core length by 68% according to the standard side-notch needle. CONCLUSIONS: Our results showed that the performance of the end-cut needle worsens with decreased stroke lengths. The end-cut needle showed high failure rates which necessitates new punctures for taking a core. Additionally, the fragmentation rates are not lower than the standard needle and it has higher rates of taking small core samples. The only significant advantage of this needle over the standard needle is taking longer cores when it has been used at 33mm stroke lengths.

Adult↗

PubMed2004

Age estimation from aspartic acid racemization of root dentin by internal standard method.

In this study, we investigated the application of the internal standard method to determine age from aspartic acid (Asp) racemization. D-Methionine (D-Met) and D-norleucine (D-Nleu) were tested as internal standards for the purpose of validating the derivatization and gas chromatographic measurements. Using a set of standard amino acids plus the internal standards in constant volume, calibration plots with reasonable linearity (R > 0.98) were constructed. Based on the analysis of sample chromatograms, D-Met appeared to meet the criteria for internal standards, hence it was selected for use in D- and L-Asp quantification. The correlation between dentin age and D-/L-Asp ratios from the peak areas as well as from the absolute concentrations was investigated. Correlation coefficients were calculated as 0.98 and 0.90, respectively. The slight decrease in accuracy was attributed to the conversion of D-Asp/D-Met ratios to concentrations employing the calibration curves figured from pure Asp. Because the application of the internal standard method produced reproducible and precise measurements, the employment of internal standards in age estimation based on Asp racemization appears to provide quality assurance by avoiding possible errors arising from sample preparation.

Adolescent↗

PubMed2005

Nurse Practitioner competency standards: findings from collaborative Australian and New Zealand research.

BACKGROUND: The title, Nurse Practitioner, is protected in most jurisdictions in Australia and New Zealand and the number of nurse practitioners is increasing in health services in both countries. Despite this expansion of the role, there is scant national or international research to inform development of nurse practitioner competency standards. OBJECTIVES: The aim of this study was to research nurse practitioner practice to inform development of generic standards that could be applied for the education, authorisation and practice of nurse practitioners in both countries. DESIGN: The research used a multi-methods approach to capture a range of data sources including research of policies and curricula, and interviews with clinicians. Data were collected from relevant sources in Australia and New Zealand. SETTINGS: The research was conducted in New Zealand and the five states and territories in Australia where, at the time of the research, the title of nurse practitioner was legally protected. PARTICIPANTS: The research was conducted with a purposeful sample of nurse practitioners from diverse clinical settings in both countries. Interviews and material data were collected from a range of sources and data were analysed within and across these data modalities. RESULTS: Findings included identification of three generic standards for nurse practitioner practice: namely, Dynamic Practice, Professional Efficacy and Clinical Leadership. Each of these standards has a number of practice competencies, each of these competencies with its own performance indicators. CONCLUSIONS: Generic standards for nurse practitioner practice will support a standardised approach and mutual recognition of nurse practitioner authorisation across the two countries. Additionally, these research outcomes can more generally inform education providers, authorising bodies and clinicians on the standards of practice for the nurse practitioner whilst also contributing to the current international debate on nurse practitioner standards and scope of practice.

Attitude of Health Personnel↗

PubMed2005

The maximum standardized uptake values on positron emission tomography of a non-small cell lung cancer predict stage, recurrence, and survival.

OBJECTIVE: We sought to assess whether the standard uptake value of a pulmonary nodule is an independent predictor of biologic aggressiveness. METHODS: This is a retrospective review of a prospective database of patients with non-small cell lung cancer. Patients had dedicated positron emission tomography scanning with F-18 fluorodeoxyglucose, with the maximum standard uptake value measured. All suspicious nodal and systemic locations on computed tomographic and positron emission tomographic scanning underwent biopsy, and when indicated, resection with complete lymphadenectomy was performed. RESULTS: There were 315 patients. Multivariate analysis showed patients with a high maximum standard uptake value (>/=10) were more likely to have poorly differentiated tumors (risk ratio, 1.5; P = .005) and advanced stage (risk ratio, 1.9; P = .010) and were less likely to have their disease completely resected (risk ratio, 3.7; P = .004). Maximum standard uptake value was the best predictor of disease-free survival (hazard ratio, 2.5; P = .039) and survival (hazard ratio, 2.8; P = .001). Stage-specific analysis showed that patients with stage IB and stage II disease with a maximum standard uptake value of greater than the median for their respective stages had a lower disease-free survival at 4 years ( P = .005 and .044). The actual 4-year survival for patients with stage Ib non-small cell lung cancer was 80% versus 66% ( P = .048), for stage II disease it was 64% versus 32% ( P = .028), and for stage IIIa disease it was 64% versus 16% ( P = .012) for the low and high maximum standard uptake value groups, respectively. CONCLUSIONS: The maximum standard uptake value of a non-small cell lung cancer nodule on dedicated positron emission tomography is an independent predictor of stage and tumor characteristics. It is a more powerful independent predictor than the TNM stage for recurrence and survival for patients with early-stage resected cancer. This information might help guide treatment strategies.

Adult↗

PubMed2004

Circulating adrenocorticotropic hormone (ACTH) and cortisol concentrations in normal, appropriate-for-gestational-age newborns versus those with sepsis and respiratory distress: Cortisol response to low-dose and standard-dose ACTH tests.

In this crossover study, we compared the peak responses of cortisol to low-dose (1 microg/1.73 m(2)) and standard-dose (250 microg/1.73 m(2)) adrenocorticotropic hormone (ACTH) stimulation tests in 90 full-term newborns (37 to 42 weeks gestational age, birthweight > 2,500 g, aged 4 to 7 days): 30 with sepsis syndrome, 30 with respiratory distress (RD) and 30 normal infants. Basal cortisol and ACTH were measured in a fasting venous sample. Serum cortisol concentrations were measured 30 minutes after low-dose ACTH and 60 minutes after standard-dose ACTH by radioimmunoassay (RIA). The mean basal circulating cortisol concentration and peak cortisol responses to low-dose and standard-dose ACTH tests were higher in stressed infants with sepsis and RD compared to normal. Basal but not ACTH-stimulated cortisol concentrations were significantly higher in newborns with sepsis versus those with RD. Circulating cortisol concentrations after the low-dose ACTH test were correlated significantly with those obtained after the standard-dose ACTH test (r = 0.814, P <.001). Clinical subgrouping of septic newborns showed that those with leukopenia (5/10 died) and with meningitis (6/12 died) had significantly lower basal and peak cortisol responses to the low-dose ACTH test (but not the standard-dose ACTH test) versus those with leukocytosis (3/20 died) and without meningitis (2/18 died), respectively. In addition, septic newborns who died had significantly lower circulating cortisol concentrations and lower cortisol responses to the low-dose ACTH test (but not the standard-dose test) versus those who survived the stress. On an individual basis, only 2 septic newborns (both died) had low basal cortisol levels (<5 microg/dL) and cortisol responses less than 15 microg/dL after the low-dose ACTH test. Four more septic newborns had basal cortisol above 5 microg/dl but cortisol responses below 20 microg/dL after the low-dose ACTH test. These 4 newborns (4/30) with inadequate adrenocortical response to low-dose ACTH during sepsis had high mortality (3/4 died) and represented a subgroup of septic newborns that should be diagnosed, using a low-dose ACTH test, and treated early. These data suggest that the low-dose ACTH test may be more disciminatory than the standard-dose test among babies under stress. Increasing the cut-point level of basal cortisol in stressed infants to the lowest level of cortisol response to low-dose ACTH in normal newborns, followed by the use of a low-dose ACTH test, appears to select some newborns who need and may improve on corticosteroid therapy. Further studies are required to investigate whether supplementation with stress doses of hydrocortisone may improve the outcome in these patients.

Adrenocorticotropic Hormone↗